A fatal crash in Tennessee focuses attention on a persistent problem for the air ambulance industry and FAA—inadequate safety regulation.

In a farmer's field two miles east of Jackson, Tenn., there's a helicopter rotor blade sticking straight out of the ground. Another medical helicopter has crashed. Another three people are dead.

It's sad, but not surprising. The medical helicopter industry has more than tripled in size over the last two decades, expanding from 200 helicopters in 1988 to 668 in 2008. While the pilots and crew endeavor to save lives, they also put their own at risk: flying to the scenes of accidents in often remote, dark locations, landing not on pads but in fields and on streets. But though the industry is the most dangerous sector of commercial aviation, it operates with some of the least safety regulation.

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Officially, "…the pilot is responsible for [the] safety of [the] aircraft and deciding whether to go forward or not," Lynn Lunsford, a spokeswoman for the Federal Aviation Administration, told CNN within hours of the crash. In other words, if he crashes, it's his fault.

No one knows yet what caused the accident in Tennessee; the National Transportation Safety Board won't release its preliminary report until 10 days after the crash. But according to local news reports, there was a thunderstorm moving across eastern Tennessee when the helicopter went down, about an hour before sunrise. The sheriff of Haywood County, where the crash happened, told a local TV news reporter that when he heard about the crash, his first thought was to wonder why anybody would fly a helicopter in such bad conditions.

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If the pilot flew into bad weather on a dark night, causing him to lose sight of the ground (known in industry speak as inadvertent flight into Instrument Flight Rule conditions), the crash may well be his fault.

But there are broader forces at work here. Helicopter ambulances have crashed 149 times since 1998, killing 140 people and seriously injuring dozens more. An industry created to save lives actually has the highest rate of fatal accidents in all of commercial aviation. In fact, working onboard a medical helicopter is the most dangerous profession in America, with a higher risk of death than fishermen, steel workers or loggers.

If the safety board determines that weather did play a role, then this latest crash fits the pattern of fatal accidents that has plagued medical helicopters since the 1970s. The board's first report on the crash epidemic, published in 1988, found that most air ambulance accidents happen when the pilot can't see, either because of weather or dark night conditions: "Weather-related accidents are the most common and most serious type of accident experienced by EMS helicopters."

Every study since then has found the same pattern. The FAA has known for 22 years why medical helicopters kill so many people. For 21 of those years, no safety standards were introduced to rectify the problem. According to John Allen, director of the FAA's Flight Standards Service: "There are only so many rule-making processes that can be accommodated at any one time because it takes research and lawyers and it's not something that the faint of heart should embark upon."

The FAA's faint heart is finally on the mend. Allen announced in 2009 that the agency would begin the years-long process of writing mandatory rules for the medical helicopter industry. The first rule should be requiring all air ambulances to be equipped with night vision goggles, which would help helicopter pilots see on dark nights and avoid bad weather.

Next the FAA should require Terrain Awareness Systems, also mandatory on all airliners, for every medical helicopter. The systems measure the distance to the ground and warn pilots to pull up when they fly too close. The agency also should require all medical helicopters to have flight data recorders to help crash investigators figure out what went wrong, improve training and avoid future accidents.

Finally, the FAA must get serious about the weather. According to early reports, the closest weather station to the farmer's field where this helicopter crashed was at a regional airport 23 miles away. That's a lot of room for intense storm cells to hide in. For years, the FAA has investigated the idea of building more weather stations to track low-altitude storm fronts in rural areas away from airports, which would give air traffic controllers the tools they need to detect small, violent storms and help helicopter pilots steer clear.

Hospital Wing, the company that operated the crash helicopter, is not required to operate a flight control center where qualified dispatchers help pilots decide whether it's safe to fly, and use sophisticated weather tracking overlaid atop moving digital maps to help pilots avoid bad weather. For years, the National Transportation Safety Board has urged the FAA to make medical helicopters safer by requiring all companies to have such control centers. It should do so, now.